RECORD OF PROCEEDINGS
PHYSICAL DISABILITY BOARD OF REVIEW

NAME:  XXXXXXXXXXXXXXXXXXXXXXX	CASE:  PD-2014-03302
BRANCH OF SERVICE:  Army 	SEPARATION DATE:  20060821

SUMMARY OF CASE:  Data extracted from the available evidence of record reflects that this covered individual (CI) was an active duty E4, Unit Supply Specialist, medically for “chronic back pain,” with a disability rating of 10%.  

CI CONTENTION:  The CI makes no specific contention in their application.  The CI’s complete submission is at Exhibit A.  

SCOPE OF REVIEW:  The Board’s scope of review is defined in DoDI 6040.44.  It is limited to those conditions determined by the Physical Evaluation Board (PEB) to be unfitting for continued military service and when specifically requested by the CI, those conditions identified by the PEB, but determined to be not unfitting.  Any conditions outside the Board’s defined scope of review and any contention not requested in this application may remain eligible for future consideration by the Board for Correction of Military Records.  Furthermore, the Board’s authority is limited to assessing the fairness and accuracy of PEB rating determinations and recommending corrections, where appropriate.  The Board’s assessment of the PEB rating determinations is based on review of medical records and all available evidence for application of the Veterans Affairs Schedule for Rating Disabilities (VASRD) standards to the unfitting medical condition at the time of separation.  The Board has neither the role nor the authority to compensate for post-separation progression or complications of service-connected conditions.  That role and authority is granted by Congress to the Department of Veterans Affairs, operating under a different set of laws.  The Board gives consideration to VA evidence, particularly within 12 months of separation, but only to the extent that it reasonably reflects the severity of the disability at the time of separation.  

RATING COMPARISON:  

SERVICE PEB - 20060629	VARD - 20070213	
Condition	Code	Rating	Condition	Code	Rating	Exam	
Chronic Back Pain	5299-5242	10%	Lumbar Spondylosis	5243	10%	20070131	
COMBINED RATING:  10%	COMBINED RATING OF ALL VA CONDITIONS:  30%	

ANALYSIS SUMMARY:  

Chronic Back Pain Condition.  According to service treatment records and the Medical Evaluation Board (MEB) narrative summary (NARSUM), the CI had a lengthy history of back pain dating back to December 1999 when she was involved in a motor vehicle accident.  She was treated conservatively in the intervening years (including completing an Iraq deployment) with profiles, non-steroidal anti-inflammatory medication, physical therapy (PT), physical and chiropractic medicine.  Magnetic resonance imaging in May 2005 showed mild disc desiccation at L4-L5 without herniation or protrusion. An Orthopedic examination on 8 March 2006 diagnosed mild degenerative disc disease and concluded the CI was not a surgical candidate.  Despite treatment, the back condition could not be adequately rehabilitated to meet the physical requirements of the CI’s military specialty and the CI was referred for a MEB.  The MEB forwarded “lumbar spondylosis” for PEB adjudication.  
At the MEB examination (recorded on DD Form 2807 and 2808) dated 24 February 2006, 6 months prior to separation, the CI reported lower back pain that “hurts severely while wearing OTV [outer tactical vest], bending, running, lifting, sometimes walking.”   Physical examination showed normal gait bilateral lower extremities motor strength, and reflexes.  Straight leg raise was negative (no radiculopathy).  There was paraspinal tenderness to palpation and decreased flexion and extension.  Pain was elicited by flexion, extension, left lateral flexion, and rotation.  The Physical Therapy examination on 27 February 2006, 6 months prior to separation, recorded limitation of flexion to 65 degrees (normal 90), extension to 25 degrees (normal 30), left lateral flexion to 20 degrees (normal 30).   All limitation of motion was due to pain.  

At the VA Compensation and Pension (C&P) examination in January 2007, performed 5 months after separation, the CI reported mid to lower back pain at times radiated into her right leg.  The pain was described as constant with occasional worsening by activity; and it varied in intensity, with the examiner recording 7/10 at the time of the report.  The CI denied associated features or symptoms due to the CI’s back condition (e.g. no bowel, bladder dysfunction, no numbness or weakness).  The CI denied incapacitating flare-ups and loss of function other than no lifting or extreme bending.  The CI said she had a brace, but did not use it due to not having to do any lifting.  The CI was fully independent and had not missed any time from work.  Physical examination showed a normal gait.  Range of motion (ROM) measurements were normal except for decreased forward flexion to 80 degrees (normal 90).  There was painful motion noted on forward flexion, decreased lordosis in the lumbar spine, and spinous and paraspinous tenderness to palpation.  Repeated and resisted motion testing did not further limit range-of-motion or function.  There were no postural abnormalities.  Neurologic examination was unremarkable. 

The Board directed attention to its rating recommendation based on the above evidence.  The PEB rated the chronic back pain condition 10% analogously coded 5299-5242 (degenerative arthritis of the spine), citing ROM limited by pain with localized tenderness without neurologic abnormality.  The VA also rated the chronic  back pain condition 10% coded 5243 (intervertebral disc syndrome), based on the VA C&P examination 5 months after separation, citing objective findings of forward flexion limited to greater than 60 degrees, but not greater than 85 degrees.  The Board agreed that a 10% rating, but no higher, was justified for limitation of flexion (greater than 60 degrees but not greater than 85 degrees) reported on the PT and VA examinations.    There was no muscle spasm or guarding severe enough to result in abnormal gait or spinal contour, thus the next higher 20% rating was not justified on this basis.  There was no evidence of intervertebral disc syndrome resulting in incapacitating episodes requiring bed rest prescribed by a physician to warrant consideration of rating under the alternate VASRD formula based on incapacitating episodes due to intervertebral disc syndrome.  There was no evidence of an associated unfitting radiculopathy for consideration of a separate peripheral nerve rating.  After due deliberation, considering all of the evidence and mindful of VASRD §4.3 (reasonable doubt), the Board concluded that there was insufficient cause to recommend a change in the PEB adjudication for the chronic back pain condition.  

BOARD FINDINGS:  In the matter of the chronic back pain condition and IAW VASRD §4.71a, the Board unanimously recommends no change in the PEB adjudication.  There were no other conditions within the Board’s scope of review for consideration.  The Board, therefore, recommends that there be no re-characterization of the CI’s disability and separation determination.  

The following documentary evidence was considered:

Exhibit A.  DD Form 294, dated 20140630, w/atchs
Exhibit B.  Service Treatment Record
Exhibit C.  Department of Veterans Affairs Treatment Record

MEMORANDUM FOR Commander, US Army Physical Disability Agency
(AHRC-DO), 2900 Crystal Drive, Suite 300, Arlington, VA 22202-3557

SUBJECT: Department of Defense Physical Disability Board of Review Recommendation
for XXXXXXXXXXXXXXXXXXXXXXX AR20160011324 (PD201403302)

I have reviewed the enclosed Department of Defense Physical Disability Board of Review
(DoD PDBR) recommendation and record of proceedings pertaining to the subject
individual. Under the authority of Title 10, United States Code, section 1554a, I accept
the Board's recommendation and hereby deny the individual's application.
This decision is final. The individual concerned, counsel (if any), and any Members of
Congress who have shown interest in this application have been notified of this decision
by mail.

BY ORDER OF THE SECRETARY OF THE ARMY:

Enclosure

CF:
( ) DoD PDBR
( ) DVA